We were pleased to see Qaseem and colleagues' guideline on noninvasive treatments for low back pain (1). However, we were surprised at the lack of caveats on treatment of older adults or discussion of the age of patients in the evidentiary trials. The stakes of improperly treated back pain may be high in older adults. Each year, nearly 17 million persons aged 65 years or older experience back pain. Age greater than 75 years and osteoporosis are “red flags” that can indicate a serious underlying pathology, such as a vertebral fracture (2). Older adults with chronic low back pain have more difficulty performing everyday tasks and more depressive symptoms (3). They are also at greater risk for adverse effects from some of the first-line medications recommended in the guideline.